How should adults educate children with speech disorders in Japan?
Graduation Thesis
Presented to
the Faculty of the Department of
English Language and Literature
Notre Dame Seishin University
In Partial Fulfillment
of the Requirement for the Degree
Bachelor of Arts
by
Erina Nakada
2014
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Contents
Abstract1
Chapter 1：What are speech disorders
1.1Introduction2
1.2 Disorders which are related to language3
1.2.1Expression Language Development Delay3
1.2.2Aphasia4
1.2.2.1 Total Aphasia5
1.2.2.2 Broca’s Aphasia5
1.2.2.3 Wernicke’s Aphasia5
1.2.2.4 Conductive Aphasia6
1.2.2.5 Transcortical Motor Aphasia7
1.2.2.6 Transcortical Sensory Aphasia7
1.2.2.7 Mixed-transcortical Aphasia8
1.2.2.8 Pure Word Dumbness8
1.2.2.9 Amnesic Aphasia (Anomic Aphasia)8
Table 1：Classification of aphasia9
1.2.2.10 Summary10
1.3Disorders which are related to speech10
1.3.1The Articulation Disorder10
1.3.1.1 FunctionalArticulation Disorder11
1.3.1.2Organic Articulation Disorder11
1.3.1.3Dysarthria12
1.3.2Dysphonia13
1.3.3Stuttering13
1.3.4Summary14
1.4Disorders which are related to communication15
1.4.1Autism15
1.4.2Attention-deficit/hyperactivity disorder (ADHD)16
1.4.3Language-based Learning Disabilities (LLD)17
1.4.4Summary18
1.5Phonetically regular and phonetically irregular19
1.6 Research questions21
1.7 Summary21
Chapter 2：Treatment
2.1 Introduction23
2.2 How to teach children with speech disorders in Japan23
2.2.1 Language Development Delay24
2.2.2Infant Aphasia27
2.2.3 Dysphonia29
2.2.4 Articulation Disorder31
2.2.5 Stuttering34
2.2.6 Autism35
2.2.7 Attention-deficit/hyperactivity disorder (ADHD)37
2.2.8 Asperger’s syndrome38
2.2.9 Learning Disabilities (LD)41
2.3 Summary43
Chapter 3：Discussion
3.1 Introduction44
3.2 American treatments44
3.2.1 Stuttering44
3.2.2.Dysphonia45
3.2.3 Speech sound disorders：Articulation and phonological processes45
3.2.4 Language-based learning disability(LLD)45
3.2.5 Attention-deficit/hyperactivity disorder (ADHD)46
3.2.6 Autism47
3.3 Comparison with Japan48
3.4 Answering research questions48
3.5 Conclusion50
References51
Websites51
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Abstract
Language is essential tool in life as a member of society. Normal children can understand what their parents and teachers say and study. When the children think they want to learn something, they can do it soon. They also communicate with their friends and parents and givetheir opinions, but children with a speech disorder can’t do these things. Children have delicate hearts, so their friends’ carelessness may hurt children with speech disorder during their conversation, and they sometimes become children with a psychological hatred of attending school or retiring children.
Chapter One shows the kinds of speech disorders. We know symptoms of speech disorder,and study about dyslexia. Dyslexia is disorder of reading and writing, and the rate that people of English area have dyslexia is twice or three times than people of Japanese area. Chapter One finds out the reason.
Chapter Two shows treatments of speech disorders, and thinks better treatments for each speech disorder. One speech disorder has some treatments but they are different by symptoms, so people need to cooperate with a medical institution and use the treatment which is proper to symptoms.
Chapter Three studies the treatments of other country and compare with Japanese treatments. We understand the differences between two countries, and think about things which adults and teachers have to do in education of children with speech disorders after this.
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Chapter 1：What are speech disorders
1.1Introduction
Language is necessary for human beings. The functions of language are self-expression, communication, the pleasure of speaking, getting one’s ideas in shape, sociable gestures, getting rid of anxiety and hostility, strengthening memory and controlling human relations and so on. Most people can acquire their first language naturally without problems but some have speech disorders.
Speech disorder is an abnormal way to talk. Sometimes understanding and expressing language are difficult. A repertoire of sound expressions which babies have changes from unclear vowel sounds to clear syllables like ‘dadadada’. Babies can’t utter words with meaning yet, so this is a pre-speech stage which can reveal speech disorders but it in normal children it is an important time as a foundation of speech development.
Japan has a system called infants diagnosis whereby each child’s development is checked when he/she is one and six months. When words with meaning don’t appear during this time, the parents worried about their children, but the difference among individuals is big, and some children speak their first word at about two years old. Speech delay times are based on arbitrary standards as to whether a delay might be individual development delay or a disorder. We will study some cases which have development delay which needs some support on the assumption that drawing a boundary line of speech and communication disorders is difficult.
1.2 Disorders related to language
Language Development Delay (LDD) is the condition in which words and syntactic skills are delayed, but there is no yardstick for judging whether it is a disorder or not. A child with LDD is one who can’t speak words with meaning and can’t understand words even though they don’t have an auditory disorder when they are over 2 years old. When they are over 3 years old, it shows up if they can speak only single words like “mama” and “this”. The following cases can reveal language development. Children with intellectual disorders and autism which includeDown’s syndromemay also have LDD. Moreover, when children with LLD enter elementary school, the words which they speak are simple, and they sometimes misuse a conjunctions and conjunctive particles (れる・られる). In short, a child with LDD is likely to have a big difference between vocabularies which is expected at that child’s life age compared to other children.
1.2.1Expression Language Development Delay
Children with this disorder have only the ability to use gestures and simple words though they can understand sentences, and expressive language is much more difficult than understanding language. This shows a state whereby only language development has a delay though non-verbal intelligence is normality.
1.2.2 Aphasia
It is a communication disorder. It’s result of damage or injury to language parts of the brain. It’s more common in older adults, particularly those who had a stroke. Aphasia gets in the way of a person’s ability to use or understand words but doesn’t impair the person’s intelligence. People with aphasia may have difficulty speaking and finding the “right” words to complete their thoughts. They may also have problems like understanding conversation, reading and comprehending written words, writing words, and using numbers. Aphasia is usually caused by a stroke or brain injury with damage to one or more parts of the brain that deal with language.
According to the US National Aphasia Association, about 25% to 40% of people who survive a stroke get aphasia. Aphasia may also be caused by a brain tumor, brain infection, or dementia such as Alzheimer’s disease. In some cases, aphasia is a symptom of epilepsy or other neurological disorders. Compared with adults and other speech disorder of infant, it is rare. If children have aphasia, people have to inspect whether they have a congenital heart disease or not by ultrasonography of heart. Children often show aphasia as a function disorder after conversion and the Landau-Kleffner syndrome which is caused by a functional brain disorder. Immediately after getting it, aphasia’s symptom is most seriously, but it recovers as time goes by. According to Lenneberg (1974.), it recovers within 5 months after showing the symptom but they can’t hope for complete recovery if the aftereffects last after this point in time. As an exception, it is possible to recover from aphasia which is caused by non-oxygen brain fever and carbon monoxide poisoning.
1.2.2.1 Total Aphasia
In total aphasia, all of language functions (hearing, speaking, reading and writing) are very bad due to damage in a wide area of fissure of Sylvius. People with total aphasia sometimes utter specific words automatically. The main examples of disease are problems in Broca’s area, Wernicke area and the arcuate fasciculus.
1.2.2.2 Broca’s Aphasia
People with Broca’s Aphasia can’t utter words and speech is non-fluent though they can understand. They are better at Kanji than kana letters when reading and writing. This model progress shows serious speech symptoms like total aphasia, but Broca’s aphasia recovers gradually, and they still have halting utterances. This cause is a pathological change of the frontal lobe Broca’s area.
1.2.2.3 Wernicke’s Aphasia
People with Wernicke’s aphasia find it difficult to understand words and things which are said and written. Their utterances are fluent but the words don’t have meaning such as “tan”, “nanda” and so on. In an acute time, they become talkative and, often can’t have subjective symptoms. The focus is Wernicke area.
[1]
Left brown part is Broca’s area, and right brown part is Wernicke’s area.
1.2.2.4 Conductive Aphasia
Understanding and expressing words are good but they make mistakes with the sound of words (they call “ringo”“dengo”), and remembering words they heard is also difficult. Especially, they make mistakes when repeating. People with this disorder notice their mistakes and correct them but they forget words that they should say because of a decline in their auditory understanding ability. The focus is arcuate fasciculus.
[2]
This is arcuate fasciculus (Raf：right arcuate fasciculus, Laf：lefy arcuate fasciculus). It connects Broca’s area and Wernicke’s area.
1.2.2.5 Transcortical Motor Aphasia
People with Transcortical Motor Aphasia have a decline in voluntary language and are good at repeating. It is said there is disfluency formally but they do not try to speak (people with Broca’s Aphasia can’t speak). In short, the amount of utterances decrease and they often repeat. The focus is the front of central ditch which surround the area for uttering words (frontal lobe).
1.2.2.6 Transcortical Sensory Aphasia
People with this disorder can recognize the sounds of words and can repeat them, but can’t understand the meanings of words. Repeating another’s words attracts attention. Utterances are fluent but they have many mistaken words. The focus is the back of central ditch which surrounds the area for uttering words (frontal lobe).
[3]
A focus of Transcortical Motor Aphasia is frontal lobe (blue). In the olden days, it was said the focus of Transcortical Sensory Aphasia is temporal lobe (green) and parietal lobe (yellow) but it is now said frontal lobe is also the focus, so people can get Transcortical Motor Aphasia or Transcortical Sensory Aphasia when frontal lobe is the focus.
1.2.2.7 Mixed-transcortical Aphasia
This aphasia is like total aphasia but people with Mixed-transcortical Aphasia often repeat. However, repeating doesn’t involve meaning’s understanding. When someone gives a suffer the first word of a proverb, people with this aphasia say a continuation of it automatically. The focuses are many parts of brain (Broca’s area, Wernicke area, arcuate fasciculus,the front and the rear of central ditch which surround the center of uttering words area and angular gyrus).
1.2.2.8 Pure Word Dumbness
Language expression by sounds is difficult but language expression by writing is possible because inner speech keeps.
1.2.2.9 Amnesic Aphasia (=Anomic Aphasia)
For this kind of aphasia, utterance and auditory understanding are normal or good comparatively. This aphasia has features whereby suffers can’t remember words and can’t express things in words. People with this aphasia often speak in a roundabout way, and sometimes can’t understand nouns. Alzheimer’s type cognitive impairment often is shown with this aphasia. They often use pronouns like “this” and “that” in conversations, and repeat topics which are not connected. The hotbed of disease is angular gyrus.
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Table 1：Classification of aphasia
Kinds of Aphasia / Mixed-Transcortical Aphasia / Amnesic Aphasia / Transcortical Sensory Aphasia / Transcortical Motor Aphasia / Total Aphasia / ConductiveAphasia / Wernicke aphasia / Broca’s Aphasiafluency / × / ○ / ○ / × / × / ○ / ○ / ×
repeat / ○ / ○ / ○ / ○ / × / × / × / ×
understanding
language / × / ○ / × / ○ / × / ○ / × / ○
name changing words / × / × / × / × / × / △ / △ / △
writing / × / × / × / × / × / × / × / ×
read aloud / × / ○ / × / × / × / × / × / ×
Understanding meanings / × / × / × / ○ / × / △ / × / △
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1.2.2.10 Summary
Children withExpression Language Development Delays aren’t delayed intellectually, so they can recover from the delay of language rapidly from a stage, and often reach normal children’s levels when they become elementary school students. However, they may have other disorders like difficulty in hearing when they notice that intellectual ability and speech ability have a big gap, so they should get an examination from a medical specialist.
Also, there are some kinds of aphasia, and the place where damage occurs for each disorder is difficult. Features of aphasia are to have disorders in four language functions (speaking, listening, reading and writing) and to have disorders in meaning of wards, grammar, a phoneme and vocabulary. Magazines and newspapers are easier to understand than a table of the Japanese syllabary for the patients, so they can write kanji if they can’t write kana.
1.3 Disorders related to speech
There is not only a delay of vocabulary and sentence but also of speech. When children begin to speak words with meaning, their pronunciation is unclear but it will be clear gradually.
1.3.1 The Articulation Disorder
Language sounds can be classified into vowels and consonants. The vowels add resonance to a sound source which is produced in the vocal cords, and are produced by strengthening a specific ingredient offrequency. On the contrary, the consonants are made by disturbing the flow of expiration, so a distortion and replacement are easy to occur.
Pronunciation is not so good. It causes a slight distortion of sound and omission of sound or replacement. When children are about 6 years old, they utter childlike pronunciation, and have a replacement of sound which is immature pronunciation. For example, they call “karasu”“tarasu”.
1.3.1.1Functional Articulation Disorder
It is most common type in infancy. It causes the omission of sounds, distortion and replacement though the phonemic organs and a neurological problem such as paralysis don’t have problems. The sound of [s] is replaced to [ʃ] and [t], and they call “sakana”“ʃakana” and “takana” when they are 6 years old.
1.3.1.2Organic Articulation Disorder
There is a problem with the construction of the phonemic organs such as lips, tongue and palate. The worst problem is it disturbs taking in nourishment such as mother’s milk. Children with a cleft palate have a problem with clearness of articulation. In general, the soft palate rises and closes a path to the nasal cavity except pronouncing a nasal sound such as [m] and [n], so a sound passes only through the mouth. If children do not only have cleft palate, but also this height of soft palate is not enough, people hear sounds which get passed to the nose. Moreover, explosive sounds like [p] and [t] which need to raise pressure in the mouth and a fricative sound like [s] are heard like nasal sounds. The pronunciation is not clear because of it.
1.3.1.3Dysarthria
Articulation movement isn’t achieved due to neurological problems such as paralysis of muscles and lack of cooperative movement. The content of massage is good but they slur their words. Content of speech and understanding are normal unless have dementia or aphasia at the same time. When an organ to utter has nerve illness like a brain blood vessel disease and tumor, this occurs. Movement disorder of an organ to utter inspects in nervous internal disease and otolaryngologist. The patients need a medical examination of brain surgery which includes image diagnosis like CT (computerizing tomography) to decide diagnosis of a brain’s pathological change and a treatment plan. Speech-Language-Hearing Therapist (ST) is in charge of an inspection of speech’s symptom. For example, the patients become in a dangerous state such as having breathing disorders when myasthenia gravis is worse. However, the symptom that speech gets past to the nose appears early, so it is often run a diagnostic check by detailed understanding of speech symptom and a medical close examination. The pronounce disorder of unknown origin needs to run a diagnostic to check it from different angles by plural specialists, so they must have inspection in a general hospital which has a speech therapy department.
1.3.2 Dysphonia
An energy source to produce voice is expiration from the lungs. If expiration isn’t impeded by anything till it produces from a lip, people can’t hear the streamas sounds. However, the way of voice has some places which can be narrow and, the vibration of air occurs and it changes to useful voice to communicate when the stream of expiration is impeded.
Children’s voice is hoarse after they continued speaking loudly because a swelling is gotten by rough treatment of voice and the vibration of voice. Change of nature of voice is temporary but when vibration of the vocal cords is irregular and you get a husky voice by having tubercle and a polyp, it is called dysphonia. However, infants have hardly it.
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1.3.3 Stuttering
Not only utterances are fluent, but also they shows physical exercise which involves tension such as gnashing one’s teeth, blinking and shaking the head. Stuttering often breaks out when children are from 2 to 6 years old. Boys often experience it more than girls (girls：boys=1：2.5～1：3). Also, when children have awareness of stuttering, they feel anxiety and fear in places to communicate.
Table2：Non-Fluent Type of Stuttering
Non-Fluent Type / Utterance Example (in Japanese)Repetition of Syllable / 「こ、これちょうだい」
Enlargement of Sound / 「どーらえもんがね」
Block / 「ｄ…どうぶつえんで見たよ」
Repetition of Word / 「たまご、たまご買ってきた」
An interjection / 「がっこう、あの、あの、行ったの」
1.3.4Summary
People record and analyze the state of articulation in free conversation and name picture cards systematically forchildren with pronunciation problems. There is anarticulation picture cards examination that all sound of Japanese is covered and consists of pictures of language familiar to the children. In an articulation examination, examiners recognize children’s pronunciation receptively, and record omissions, distortion and replacement of sounds while using a sound letter, so examiners need the this skill. In addition, examiners look into whether they can form the tongue or not (movement of articulation organ) and whether they can recognize two different sounds or not (the sound of a ward distinction).
1.4 Disorders which are related to communication
1.4.1 Autism
Usually children start speaking before 1 year old, and they understand what adults say from a few monthslater. Parents who have autistic children encounter a phenomenon that they call their children’s name but the children don’t turn their faces. The parents often doubt their difficulty in hearing. However, children react to television commercials and the sound to open snack bags and sounds coming from the next room. Thus, autistic babies seem to respond to noise but respond to voice gradually but they respond to a clue except voice.